Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
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Contract Specialist
Summary of Position
- Load all Professional, Facility, and Ancillary contracts across all EmblemHealth lines of business in a timely and accurate
manner. - Provide subject matter expertise in all areas of contract configuration, fee schedules/groupers, and rate reimbursement.
- Collaborate on workflows and business processes to ensure efficient interaction with Network Development, Analytics, and
other business areas to facilitate accurate translation and maintenance of contractual agreements into Network. - Develop expertise in the downstream impact of loaded rates within EmblemHealth’s full claims reimbursement cycle.
Principal Accountabilities
- Participate in all aspects of provider, facility, and ancillary rate configurations in Network within set deadlines, while
ensuring full accuracy of contract loads. - Collaborate with Network Management and Analytics to ensure proper capture of negotiated and modeled
contractual agreements. - Identify and correct rate load problems.
- Assist with the contract configuration, fee schedule / grouper, and rate reimbursement matters.
- Analyze negotiated contracts to determine Network interaction with the core systems ensuring that reimbursement
is in line with negotiated intent. - In coordination with Network Management, update all evergreen contracts in a timely manner.
- Recommend contract language changes to be in line with system reimbursement capabilities.
- Coordinate rate testing with BTS.
Qualifications
Education, Training, Licenses, Certifications
- B. S. degree in Business Operations, Information Systems or equivalent.
- Master’s Degree a plus but not required.
Relevant Work Experience, Knowledge, Skills, and Abilities
- Minimum 2-3 years of relevant experience, preferably in a health care environment.
- Strong familiarity with EmblemHealth’s claims systems and interdependent applications.
- Experience in provider, facility, and ancillary contract files set-ups, maintenance, testing and auditing functions.
- Experience in establishing and accomplishing business strategies to successfully translate contractual language into system
reimbursement specifications. - Excellent knowledge of medical terminology, Fee Schedules, and ICD/CPT/HCPCS coding.
- Understanding of Government reimbursement methodologies.
- Analytic, problem solver, excellent organizational and technical skills and attention to detail are required.
Security Disclosure
If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.
Pay Disclosure
At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.